Degenerative disc

Overview

Degenerative disc disease commonly occurs with age, as discs become more
brittle, less resilient and more prone to herniation. Degenerative
disc disease is the single most common diagnosis related to serious
back and neck pain. When a disc herniates in the spine, the surgeon
can sometimes simply remove a portion of the disc. In other cases,
where the disc is more damaged and must be removed, something must
be placed into the disc space. Otherwise, the two vertebrae will collapse
on top of one another, placing pressure on the nerve roots that branch
off from the spinal cord.
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Causes

Some of the contributing factors of degenerative disc disease are family
history, lifestyle and age. The prime age for disc-related problems
is after 35. If a parent had back or neck surgery for a herniated disc,
you should be particularly concerned about taking care of your back.
Lifestyle is another important factor. Those who perform frequent lifting
or put themselves in situations where the spine is exposed to trauma
or repetitive shock can also develop degenerative discs over time.

Osteoporosis can lead to disc degeneration. As bones weaken,
a person becomes increasingly at risk for vertebral fractures.

Symptoms

Diagnosis

Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan for your condition.

Medical history: Conducting a detailed
medical history helps the doctor better understand the possible causes
of your back and neck pain which can help outline the most appropriate
treatment.

Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.

X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.

MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.

CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.

Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.

Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.

Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are
performed to view the disc composition to determine if its structure
is normal or abnormal. In addition to the disc appearance, your doctor
will note any pain associated with this injection. The benefit of a
discogram is that it enables the physician to confirm the disc level
that is causing your pain. This ensures that surgery will be more successful
and reduces the risk of operating on the wrong disc.

Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.

Treatment

A typical solution for problems related to DDD is a spinal
fusion procedure.The main problem with fusion surgeries is that they
don't often turn out well. While some studies claim a success rate of
about 75 percent, that still leaves one in four surgeries as not successful.
The second problem with fusion surgery is that there is a reduction in
mobility that can cause other problems over time Because the fusion locks a vertebral segment from rotating, it causes more stress on the level above and below the fused site, which in turn can herniate these other discs. Thankfully,
there is an alternative today—artificial
disc implantation.

Dietary supplements or medications may be recommended to
treat degenerative disc disease that is linked to osteoporosis.

FAQ

What is degenerative disc disease?

A natural byproduct of aging is the loss of resiliency in spinal discs
and a greater tendency for them to herniate, especially when placed under
a weighty load, like when we lift heavy objects. Additionally, some people
have a family history of degenerative disc disease, which increases their
own risk of developing it. When a natural disc herniates or becomes badly
degenerated, it loses its shock-absorbing ability, which can narrow the
space between vertebrae.

Who is a candidate for the artificial
disc?

Patients with a diseased disc between L4 and L5 or between L5 and S1
(all in the lower back) that is worn out or become injured and causes
back pain are candidates for the artificial disc. Other candidates include
those with degenerative disc disease (DDD) whose bones (vertebrae) have
moved less than 3mm. Your physician will help you determine whether or
not the artificial disc is a good choice for you. Factors that will be
considered include your activity level, weight, occupation and allergies.

What are the benefits of the artificial
disc?

Generally speaking, those who receive artificial disc replacements return
to activity sooner than traditional fusion patients. Also, because there
is no need to harvest bone from the patient’s hip, there is no
discomfort or recovery associated with a second incision site. Some of
the overall benefits of artificial disc surgery include:

Retains movement and stability of the spine

Prevents degeneration of surrounding segments

No bone graft required

Quicker recovery and return to work

Less invasive and painful than a fusion

Reduces pain associated with disc disease

While the artificial disc may well be a promising new technology,
most spine surgeons today are very cautious. There are many serious
concerns including:

Constantly changing technology as new discs are coming
out that last longer and may be easier to insert and remove

The life span of the implants are in question

What happens if the implant needs to be removed

Consult with your spine surgeon to determine your best
option. Click here to
learn more about the artificial disc.

Where to find us

Kenai Spine is the only spine center in the State of Alaska to be included in Spine Center Network, an exclusive national listing of spine centers of excellence that meet credentialing criteria related to fellowship-trained spine surgeons; non-surgical Mayo Clinic-trained MD physical medicine specialist for back and neck pain; and affiliated spine therapists. With an office on the Kenai Peninsula, and two offices in Anchorage, Kenai Spine provides great convenience to those with back pain or neck pain problems who live around Anchorage, including Wasilla, Palmer, Eagle River and the Mat-Su Valley. Click here for directions to our Anchorage offices or our main office in Soldotna on the Kenai Peninsula.

Home Remedy Book

Our spine Internet site acts as on-line spine encyclopedia. In addition, as a free community service, Kenai Spine mails out Home Remedy Books on a limited basis to residents in Alaska. Click here to learn more.

Second Opinions

For those back and neck pain sufferers who have exhausted nonsurgical treatment options, spine surgery may be the next step in resolving a spine problem. Because spine surgery is a serious decision, it is a good idea to obtain a second opinion. Click here to learn more.

Back to Life

We provide a 16-page Back to Life Journal featuring information on the latest treatment options for back and neck pain. To subscribe, please click here.

Symptoms Chart

What do your symptoms indicate? Some symptoms represent emergencies and need to be seen immediately by a spine specialist. Click here to learn more.